HERS Request Form

    1. HomeOwner Information

    Project Address:(Required)

    City & State:(Required)

    Zip Code:(Required)

    Homeowner Name:(Required)

    Homeowner Phone:(Required)

    Homeowner Email:(Required)

    2. HVAC Installer Information

    Contractors License #:(Required)

    HVAC Installer Co. Name:(Required)

    HVAC Installer Contact Name:(Required)

    HVAC Installer Phone:(Required)

    HVAC Installer Email Address:(Required)

    3. Billing & Signature Information

    Contact for Scheduling Test:(Required)

    Registered CalCERTS User?(Required)

    Responsible Party for Certificate Approvals?(Required)

    Responsible for Payment?(Required)

    Preferred Method of Payment?(Required)

    4. Installation & Project Information

    Project Type:(Required)

    Installation Date:(Required)

    Permit Number:(Required)

    Permit Date:(Required)

    Building Department:(Required)

    Square Footage of Home:(Required)

    Number of Bedrooms:(Required)

    Duct System:(Required)

    Heating System Type:(Required)

    How Many New HVAC Systems?(Required)

    Altered Heating Components:(Required)

    Cooling System Type:(Required)

    Altered Cooling Components:(Required)

    Email of Person Ordering HERS Testing:(Required)

    Comments:

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